Vaccine Pricing

Vaccine Pricing
Seasonal Flu Vaccines

Part B payment allowance limits for seasonal influenza (flu) vaccines (that is, the vaccine product) are 95% of the Average Wholesale Price (AWP). In hospital outpatient departments, payment is based on reasonable cost.

Part B deductible and coinsurance amounts don’t apply for flu vaccine products or their administration. With respect to the vaccine product, all providers and suppliers must accept assignment on the claim.

The annual flu vaccine season is August 1–July 31 of the following year.

Get more information on frequency & coverage, billing, and coding.

Flu Season Payment Allowances & Effective Dates

  • Payment Allowances and Effective Dates for the 2023-2024 Flu Season:

CodeLabeler NameVaccine NamePayment AllowanceEffective Dates
90662Sanofi PasteurFluzone High-Dose Quadrivalent (2023/2024)

$73.403

08/01/2023 – 07/31/2024
90672MedImmuneFluMist Quadrivalent (2023/2024)

$27.788

08/01/2023 – 07/31/2024
90674SeqirusFlucelvax Quadrivalent (2023/2024) (Preservative Free)

$34.172

08/01/2023 – 07/31/2024
90682Sanofi PasteurFlublok Quadrivalent (2023/2024) (Preservative Free)

$73.403

08/01/2023 – 07/31/2024
90686GlaxoSmithKline

Fluarix Quadrivalent (2023/2024) (Preservative free)

Flulaval Quadrivalent (2023/2024) (Preservative Free)

$22.350

08/01/2023 – 07/31/2024
Sanofi PasteurFluzone Quadrivalent (2023/2024) (Preservative Free)
SeqirusAfluria Quadrivalent (2023/2024) (Preservative Free)
90687Sanofi PasteurFluzone Quadrivalent 0.25ml (2023/2024)

$10.439

08/01/2023 – 07/31/2024
SeqirusAfluria Quadrivalent 0.25ml (2023/2024)
90688Sanofi PasteurFluzone Quadrivalent (2023/2024)

$20.878

08/01/2023 – 07/31/2024
SeqirusAfluria Quadrivalent (2023/2024)
90694SeqirusFluad Quadrivalent (2023/2024) (Preservative Free)

$77.359

08/01/2023 – 07/31/2024
90756SeqirusFlucelvax Quadrivalent (2023/2024)

$32.374

08/01/2023 – 07/31/2024

Payment limits and effective dates for newly approved and marketed influenza vaccines will be posted to this webpage.

  • Payment Allowances and Effective Dates for the 2022-2023 Flu Season:

CodeLabeler NameVaccine NamePayment AllowanceEffective Dates
90662Sanofi PasteurFluzone High-Dose Quadrivalent (2022/2023)$ 69.94108/01/2022 – 07/31/2023
90672MedImmuneFluMist Quadrivalent (2022/2023)$ 26.87608/01/2022 – 07/31/2023
90674SeqirusFlucelvax Quadrivalent (2022/2023) (Preservative Free)$ 32.27808/01/2022 – 07/31/2023
90682Sanofi PasteurFlublok Quadrivalent (2022/2023) (Preservative Free)$ 69.94108/01/2022 – 07/31/2023
90686

GlaxoSmithKline

Sanofi Pasteur

Seqirus

Fluarix Quadrivalent (2022/2023) (Preservative Free)
Flulaval Quadrivalent (2022/2023) (Preservative Free)
Fluzone Quadrivalent (2022/2023) (Preservative Free)
Afluria Quadrivalent (2022/2023) (Preservative Free)
$ 21.51808/01/2022 – 07/31/2023
90687

Sanofi Pasteur

Seqirus

Fluzone Quadrivalent 0.25ml (2022/2023)
Afluria Quadrivalent 0.25ml (2022/2023)
$ 10.24108/01/2022 – 07/31/2023
90688

Sanofi Pasteur

Seqirus

Fluzone Quadrivalent (2022/2023)
Afluria Quadrivalent (2022/2023)
$ 20.48208/01/2022 – 07/31/2023
90694SeqirusFluad Quadrivalent (2022/2023) (Preservative Free)$ 71.68208/01/2022 – 07/31/2023
90756SeqirusFlucelvax Quadrivalent (2022/2023)$ 30.58108/01/2022 – 07/31/2023

Payment limits and effective dates for newly approved and marketed influenza vaccines will be posted to this webpage.

Locality-Adjusted Payment Rates

Archive Documents

COVID-19 Vaccines & Monoclonal Antibodies

The COVID-19 public health emergency (PHE) ended at the end of the day on May 11, 2023. View Infectious diseases for a list of waivers and flexibilities that were in place during the PHE.

Review this page for information about Medicare payment for administering COVID-19 vaccines and monoclonal antibodies during and after the PHE.

Medicare Part B Payment for COVID-19 Vaccines & Certain Monoclonal Antibodies

This webpage provides the payment allowances and other related information for COVID-19 vaccines and certain monoclonal antibody products. Review the COVID-19 provider toolkit for more information about Medicare and COVID-19 during and after the PHE.

Payment Allowances & Effective Dates for COVID-19 Vaccines & Their Administration: (DOS = Date of Service, TBD = To Be Determined)

CPT Code or HCPCS CodeCPT or HCPCS Short DescriptorLabeler NameVaccine/Procedure NameNational Payment Allowance Effective for Claims with DOS on or after 03/15/2021National Payment Allowance Effective for Claims with DOS through 03/14/2021Effective Dates for Medicare Payment
90480ADMN SARSCOV2 VACC 1 DOSEN/AN/A$40.000[2]Code not active during this time09/11/2023 - TBD
M0201Covid-19 vaccine home adminHome vaccine adminCovid-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when only covid-19 vaccine administration is performed at the patient's home$35.50[2]Code not active during this time06/08/2021 - TBD
91304SARSCOV2 VAC 5MCG/0.5ML IMNovavaxNovavax Covid-19 Vaccine, Adjuvanted (Aged 12 years and older)$148.200[7]Code not active during this time07/13/2022 – TBD
91318SARSCOV2 VAC 3MCG TRS-SUCPfizer-BioNTechPfizer-BioNTech COVID-19 Vaccine 2023-2024 Formula (Yellow Cap)$65.550Code not active during this time

09/11/2023 - TBD

 

91319SARSCV2 VAC 10MCG TRS-SUC IMPfizer-BioNTechPfizer-BioNTech COVID-19 Vaccine 2023-2024 Formula (Blue Cap)$87.780Code not active during this time09/11/2023 - TBD
91320SARSCV2 VAC 30MCG TRS-SUC IMPfizer-BioNTechCOMIRNATY (COVID-19 Vaccine, mRNA) 2023-2024 Formula$131.100Code not active during this time09/11/2023 - TBD
91321SARSCOV2 VAC 25 MCG/.25ML IMModernaModerna COVID-19 Vaccine 2023-2024 Formula$145.920Code not active during this time09/11/2023 - TBD
91322SARSCOV2 VAC 50 MCG/0.5ML IMModernaSPIKEVAX 2023-2024 Formula$145.920Code not active during this time09/11/2023 - TBD
91300SARSCOV2 VAC 30MCG/0.3ML IMPfizerPfizer-BioNTech Covid-19 Vaccine (Aged 12 years and older) (Purple Cap)$0.010[1]$0.010[1]12/11/2020 – 04/18/2023
0001AADM SARSCOV2 30MCG/0.3ML 1STPfizerPfizer-BioNTech Covid-19 Vaccine (Purple Cap) Administration – First Dose$40.000[2]$16.940[2]12/11/2020 – 04/18/2023
0002AADM SARSCOV2 30MCG/0.3ML 2NDPfizerPfizer-BioNTech Covid-19 Vaccine (Purple Cap) Administration – Second Dose$40.000[2]$28.390[2]12/11/2020 – 04/18/2023
0003AADM SARSCOV2 30MCG/0.3ML 3RDPfizerPfizer-BioNTech Covid-19 Vaccine (Purple Cap) Administration – Third Dose$40.000[2]Code not active during this time08/12/2021 – 04/18/2023
0004A[4]ADM SARSCOV2 30MCG/0.3ML BSTPfizerPfizer-BioNTech Covid-19 Vaccine (Purple Cap) Administration – Booster$40.000[2]Code not active during this time09/22/2021 – 04/18/2023
91301SARSCOV2 VAC 100MCG/0.5ML IMModernaModerna Covid-19 Vaccine (Aged 12 years and older) (Red Cap)$0.010[1]$0.010[1]12/18/2020 – 04/18/2023
0011AADM SARSCOV2 100MCG/0.5ML1STModernaModerna Covid-19 Vaccine (Red Cap) Administration – First Dose$40.000[2]$16.940[2]12/18/2020 – 04/18/2023
0012AADM SARSCOV2 100MCG/0.5ML2NDModernaModerna Covid-19 Vaccine (Red Cap) Administration – Second Dose$40.000[2]$28.390[2]12/18/2020 – 04/18/2023
0013AADM SARSCOV2 100MCG/0.5ML3RDModernaModerna Covid-19 Vaccine (Red Cap) Administration – Third Dose$40.000[2]Code not active during this time08/12/2021 – 04/18/2023
91303SARSCOV2 VAC AD26 .5ML IMJanssenJanssen Covid-19 Vaccine (Aged 18 years and older)[3]$0.010[1]$0.010[1]02/27/2021 – 06/01/2023
0031AADM SARSCOV2 VAC AD26 .5MLJanssenJanssen Covid-19 Vaccine Administration - First Dose[3]$40.000[2]$28.390[2]02/27/2021 – 06/01/2023
0034AADM SARSCOV2 VAC AD26 .5ML BJanssenJanssen Covid-19 Vaccine Administration -  Booster[3]$40.000[2]Code not active during this time10/20/2021 – 06/01/2023
0041AADM SARSCOV2 5MCG/0.5ML 1STNovavaxNovavax Covid-19 Vaccine, Adjuvanted  Administration – First Dose$40.000[2]Code not active during this time07/13/2022 – 10/03/2023
0042AADM SARSCOV2 5MCG/0.5ML 2NDNovavaxNovavax Covid-19 Vaccine, Adjuvanted  Administration – Second Dose$40.000[2]Code not active during this time07/13/2022 – 10/03/2023
0044AADM SARSCOV2 5MCG/0.5ML BSTNovavaxNovavax Covid-19 Vaccine, Adjuvanted Administration - Booster$40.000[2]Code not active during this time10/19/2022 – 10/03/2023
91305SARSCOV2 VAC 30 MCG TRS-SUCRPfizerPfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Aged 12 years and older) (Gray Cap)$0.010[1]Code not active during this time01/03/2022 – 04/18/2023
0051AADM SARSCV2 30MCG TRS-SUCR 1PfizerPfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - First dose$40.000[2]Code not active during this time01/03/2022 – 04/18/2023
0052AADM SARSCV2 30MCG TRS-SUCR 2PfizerPfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Second dose$40.000[2]Code not active during this time01/03/2022 – 04/18/2023
0053AADM SARSCV2 30MCG TRS-SUCR 3PfizerPfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Third dose$40.000[2]Code not active during this time01/03/2022 – 04/18/2023
0054A[4]ADM SARSCV2 30MCG TRS-SUCR BPfizerPfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Booster$40.000[2]Code not active during this time01/03/2022 – 04/18/2023
91306SARSCOV2 VAC 50MCG/0.25ML IMModernaModerna Covid-19 Vaccine (Aged 18 years and older) (Red Cap) (Low Dose)$0.010[1]Code not active during this time10/20/2021 – 04/18/2023
0064A[4]ADM SARSCOV2 50MCG/0.25MLBSTModernaModerna Covid-19 Vaccine (Red Cap) (Low Dose) Administration - Booster$40.000[2]Code not active during this time10/20/2021 – 04/18/2023
91307SARSCOV2 VAC 10 MCG TRS-SUCRPfizerPfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 5 years through  11 years) (Orange Cap)$0.010[1]Code not active during this time10/29/2021 - 04/18/2023
0071AADM SARSCV2 10MCG TRS-SUCR 1PfizerPfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration - First dose$40.000[2]Code not active during this time10/29/2021 - 04/18/2023
0072AADM SARSCV2 10MCG TRS-SUCR 2PfizerPfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration - Second dose$40.000[2]Code not active during this time10/29/2021 - 04/18/2023
0073AADM SARSCV2 10MCG TRS-SUCR 3PfizerPfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration - Third dose$40.000[2]Code not active during this time01/03/2022 - 04/18/2023
0074A[4]ADM SARSCV2 10MCG TRS-SUCR BPfizerPfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration - Booster$40.000[2]Code not active during this time05/17/2022 - 04/18/2023
91308SARSCOV2 VAC 3MCG TRS-SUCRPfizerPfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap)$0.010[1]Code not active during this time06/17/2022 - 04/18/2023
0081AADM SARSCOV2 3MCG TRS-SUCR 1PfizerPfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration - First dose$40.000[2]Code not active during this time06/17/2022 - 04/18/2023
0082AADM SARSCOV2 3MCG TRS-SUCR 2PfizerPfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration - Second dose$40.000[2]Code not active during this time06/17/2022 - 04/18/2023
0083AADM SARSCOV2 3MCG TRS-SUCR 3PfizerPfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration - Third dose$40.000[2]Code not active during this time06/17/2022 - 04/18/2023
91309SARSCOV2 VAC 50MCG/0.5ML IMModernaModerna Covid-19 Vaccine (Aged 6 years through 11 years or aged 18 years and older) (Blue Cap with purple border) 50MCG/0.5ML[5]$0.010[1]Code not active during this time03/29/2022 - 04/18/2023
0091AADM SARSCOV2 50 MCG/.5 ML1STModernaModerna Covid-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration - First dose$40.000[2]Code not active during this time06/17/2022 - 04/18/2023
0092AADM SARSCOV2 50 MCG/.5 ML2NDModernaModerna Covid-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration - Second dose$40.000[2]Code not active during this time06/17/2022 - 04/18/2023
0093AADM SARSCOV2 50 MCG/.5 ML3RDModernaModerna Covid-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration - Third dose$40.000[2]Code not active during this time06/17/2022 - 04/18/2023
0094A[4]ADM SARSCOV2 50MCG/0.5 MLBSTModernaModerna Covid-19 Vaccine (Aged 18 years and older) (Blue Cap with purple border) 50MCG/0.5ML Administration - Booster$40.000[2]Code not active during this time03/29/2022 - 04/18/2023
91311SARSCOV2 VAC 25MCG/0.25ML IMModernaModerna Covid-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) 250MCG/0.25ML$0.010[1]Code not active during this time06/17/2022 - 04/18/2023
0111AADM SARSCOV2 25MCG/0.25ML1STModernaModerna Covid-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration - First dose$40.000[2]Code not active during this time06/17/2022 - 04/18/2023
0112AADM SARSCOV2 25MCG/0.25ML2NDModernaModerna Covid-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration - Second dose$40.000[2]Code not active during this time06/17/2022 - 04/18/2023
0113AADM SARSCOV2 25MCG/0.25ML3RDModernaModerna Covid-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration - Third dose$40.000[2]Code not active during this time06/17/2022 - 04/18/2023
91312SARSCOV2 VAC BVL 30MCG/0.3MPfizerPfizer-BioNTech COVID-19 Vaccine, Bivalent Product (Aged 12 years and older) (Gray Cap)$0.010[1]Code not active during this time08/31/2022 – 09/12/2023
0124AADM SARSCV2 BVL 30MCG/.3ML BPfizerPfizer-BioNTech COVID-19 Vaccine, Bivalent (Aged 12 years and older) (Gray Cap) Administration – Additional Dose$40.000[2]Code not active during this time08/31/2022 – 09/12/2023
91313SARSCOV2 VAC BVL 50MCG/0.5MLModernaModerna COVID-19 Vaccine, Bivalent Product (Aged 12 years and older) (Dark Blue Cap with gray border)[6]$0.010[1]Code not active during this time08/31/2022 – 09/12/2023[6]
0134AADM SARSCV2 BVL 50MCG/.5ML BModernaModerna COVID-19 Vaccine, Bivalent (Aged 12 years and older) (Dark Blue Cap with gray border) Administration – Additional Dose[6]$40.000[2]Code not active during this time08/31/2022 – 09/12/2023[6]
91314SARSCOV2 VAC BVL 25MCG/0.25MLModernaModerna COVID-19 Vaccine, Bivalent Product (Aged 6 months through 11 years) (Dark Blue Cap with gray border)$0.010[1]Code not active during this time10/12/2022 – 09/12/2023
0144AADM SARSCV2 BVL 25MCG/.25ML BModernaModerna COVID-19 Vaccine, Bivalent (Aged 6 years through 11 years) (Dark Blue Cap with gray border) Administration – Additional Dose$40.000[2]Code not active during this time10/12/2022 – 09/12/2023
91315SARSCOV2 VAC BVL 10MCG/0.2MLPfizerPfizer-BioNTech COVID-19 Vaccine, Bivalent Product (Aged 5 years through 11 years) (Orange Cap)$0.010[1]Code not active during this time10/12/2022 – 09/12/2023
0154AADM SARSCV2 BVL 10MCG/.2ML BPfizerPfizer-BioNTech COVID-19 Vaccine, Bivalent Product (Aged 5 years through 11 years) (Orange Cap) Administration – Additional Dose$40.000[2]Code not active during this time10/12/2022 – 09/12/2023
91316SARSCOV2 VAC BVL 10MCG/0.2MLModernaModerna COVID-19 Vaccine, Bivalent Product (Aged 6 months through 5 years) (Dark Pink Cap and a label with a yellow box)$0.010[1]Code not active during this time12/08/2022 – 09/12/2023
0164AADM SRSCV2 BVL 10MCG/0.2ML BModernaModerna COVID-19 Vaccine, Bivalent (Aged 6 months through 5 years) (Dark Pink Cap and label with a yellow box) Administration – Additional Dose$40.000[2]Code not active during this time12/08/2022 – 09/12/2023
91317SARSCOV2 VAC BVL 3MCG/0.2MLPfizerPfizer-BioNTech COVID-19 Vaccine, Bivalent Product (Aged 6 months through 4 years) (Maroon Cap)$0.010[1]Code not active during this time12/08/2022 – 09/12/2023
0173AADM SARSCV2 BVL 3MCG/0.2ML 3PfizerPfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration - Additional Dose$40.000[2]Code not active during this time12/08/2022 – 09/12/2023
0174AADM SARSCV2 BVL 3MCG/0.2ML BPfizerPfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration  – Additional Dose$40.000[2]Code not active during this time03/14/2023 – 09/12/2023
0121AADM SARSCV2 BVL 30MCG/.3ML 1PfizerPfizer-BioNTech COVID-19 Bivalent (12 years and older) Administration – Single Dose$40.000[2]Code not active during this time04/18/2023 - 09/12/2023
0151AADM SARSCV2 BVL 10MCG/.2ML 1PfizerPfizer-BioNTech COVID-19 Bivalent Pediatric Vaccine (5 years through 11 years) Administration – Single Dose$40.000[2]Code not active during this time04/18/2023 - 09/12/2023
0171AADM SARSCV2 BVL 3MCG/0.2ML 1PfizerPfizer-BioNTech COVID-19 Bivalent Pediatric Vaccine (6 months through 4 years) Administration – First Dose$40.000[2]Code not active during this time04/18/2023 - 09/12/2023
0172AADM SARSCV2 BVL 3MCG/0.2ML 2PfizerPfizer-BioNTech COVID-19 Bivalent Pediatric Vaccine (6 months through 4 years) Administration – Second Dose$40.000[2]Code not active during this time04/18/2023 - 09/12/2023
0141AADM SRSCV2 BVL 25MCG/.25ML 1ModernaModerna COVID-19 Vaccine, Bivalent Pediatric Vaccine (6 months through 11 years) Administration – First Dose$40.000[2]Code not active during this time04/18/2023 - 09/12/2023
0142AADM SRSCV2 BVL 25MCG/.25ML 2ModernaModerna COVID-19 Vaccine, Bivalent Pediatric Vaccine (6 months through 11 years) Administration – Second Dose$40.000[2]Code not active during this time04/18/2023 - 09/12/2023

[1] Since we anticipate that providers, initially, won’t incur a cost for the product, CMS will update the payment allowance at a later date. Providers shouldn’t bill for the product if they got it for free.

[2] We’ll also geographically adjust these rates for many providers. We’ve included files with the geographically adjusted payment rates for COVID-19 vaccine administration in the “Additional Resources” section below. Certain settings use other payment methodologies, such as payment based on reasonable costs. Starting January 1, 2023, we’ll also annually update the COVID-19 vaccine payment rates to reflect changes in costs related to administering preventive vaccines.

[3] Johnson & Johnson COVID-19 vaccine. On May 5, 2022, the FDA limited the authorized use of the Janssen COVID-19 vaccine. On June 1, 2023, FDA revoked the EUA for this vaccine.

[4] Administration booster codes should be billed for all applicable booster doses as approved and/or authorized by the FDA.

[5] On June 17, 2022, FDA authorized the 50MCG/0.5ML presentation of the Moderna COVID-19 vaccine to provide primary series doses in individuals 6 - 11 years of age in addition to the March 29, 2022, FDA authorization to provide booster vaccination doses in individuals 18 years and older.

[6] On October 12, 2022, the FDA authorized the Moderna bivalent product (dark blue cap with gray border) and its administration for use as a single booster dose in individuals 12 - 17 years old in addition to the August 31, 2022, FDA authorization as a single booster dose in individuals 18 years and older.

[7] Effective October 3, 2023, CMS updated the payment allowance. Providers shouldn’t bill for the product if they got it for free.

Payment Allowances & Effective Dates for COVID-19 Monoclonal Antibodies & Their Administration:

HCPCS CodeHCPCS Short DescriptorLabeler NameVaccine/Procedure NameNational Payment Allowance Effective for Claims with DOS on or after 05/6/2021National Payment Allowance Effective for Claims with DOS through 05/5/2021Effective Dates

Q0220

Note: This product isn’t currently authorized[12]

Tixagev and cilgav, 300mgAstraZenecaInjection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 300 mg$0.010[1]Code not active during this time period12/08/2021 - TBD

Q0221

Note: This product isn’t currently authorized[12]

Tixagev and cilgav, 600mgAstraZenecaInjection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 600 mg$0.010[1]Code not active during this time period02/24/2022 - TBD

M0220

Note: This product isn’t currently authorized[12]

Tixagev and cilgav injAstraZenecaInjection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring$150.50[3]Code not active during this time period12/08/2021 - TBD

M0221

Note: This product isn’t currently authorized[12]

Tixagev and cilgav inj hmAstraZeneca

Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency

 

$250.50[3]Code not active during this time period12/08/2021 - TBD

Q0222

Note: This product isn’t currently authorized[11]

Bebtelovimab 175 mgEli LillyInjection, bebtelovimab, 175 mg$2394.00[1] [1a]Code not active during this time period02/11/2022 - TBD

M0222

Note: This product isn’t currently authorized[11]

Bebtelovimab injectionEli LillyIntravenous injection, bebtelovimab, includes injection and post administration monitoring$350.50[3]Code not active during this time period02/11/2022 - TBD

M0223

Note: This product isn’t currently authorized[11]

Bebtelovimab injection homeEli LillyIntravenous injection, bebtelovimab, includes injection and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency$550.50[3]Code not active during this time period02/11/2022 - TBD
Q0239Bamlanivimab-xxxxEli LillyInjection, bamlanivimab, 700 mgCode not active during this time period $0.010[1]11/10/2020 – 04/16/2021[4]
M0239Bamlanivimab-xxxx infusionEli LillyIntravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoringCode not active during this time period$309.600[3]11/10/2020 – 04/16/2021[4]
Q0240[6]
Note: This product isn’t currently authorized[9]
Casirivi and imdevi 600mgRegeneronInjection, casirivimab and imdevimab, 600 mg$0.010[1]Code not active during this time period07/30/2021 – TBD
M0240[6]
Note: This product isn’t currently authorized[9]
Casiri and imdev repeatRegeneronIntravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses$450.00[3]Code not active during this time period07/30/2021 – TBD
M0241[6]
Note: This product isn’t currently authorized[9]
Casiri and imdev repeat hmRegeneronIntravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence, this includes a beneficiary's home that has been made provider-based to the hospital during the covid-19 public health emergency, subsequent repeat doses$750.00[3]Code not active during this time period07/30/2021 – TBD
Q0243
Note: This product isn’t currently authorized[9]
Casirivimab and imdevimabRegeneronInjection, casirivimab and imdevimab, 2400 mg$0.010[1]$0.010[1]11/21/2020 – TBD
M0243
Note: This product isn’t currently authorized[9]
Casirivi and imdevi injRegeneronIntravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring$450.00[3]$309.600[3]11/21/2020 – TBD
Q0244[5]
Note: This product isn’t currently authorized[9]
Casirivi and imdevi 1200 mgRegeneronInjection, casirivimab and imdevimab, 1200 mg$0.010[1]$0.010[1]06/03/2021 – TBD
M0244
Note: This product isn’t currently authorized[9]
Casirivi and imdevi inj hmRegeneronIntravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency$750.00[3]Code not active during this time period05/06/2021 – TBD
Q0245[8]
Note: This product isn’t currently authorized[9]
Bamlanivimab and etesevimaEli LillyInjection, bamlanivimab and etesevimab, 2100 mg$0.010[1]$0.010[1]02/09/2021 – TBD
M0245[8]
Note: This product isn’t currently authorized[9]
Bamlan and etesev infusionEli Lillyintravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring$450.00[3]$309.600[3]02/09/2021 – TBD
M0246[8]
Note: This product isn’t currently authorized[9]
Bamlan and etesev infus homeEli LillyIntravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency$750.00[3]Code not active during this time period05/06/2021 – TBD

Q0247[7]

Note: This product isn’t currently authorized[10]

SotrovimabGSKInjection, sotrovimab, 500 mg$2394.00Code not active during this time period05/26/2021 – TBD

M0247

Note: This product isn’t currently authorized[10]

Sotrovimab infusionGSKIntravenous infusion, sotrovimab, includes infusion and post administration monitoring$450.00[3]Code not active during this time period05/26/2021 – TBD

M0248

Note: This product isn’t currently authorized[10]

Sotrovimab inf, home adminGSKIntravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency$750.00[3]Code not active during this time period05/26/2021 – TBD
Q0249[2]Tocilizumab for COVID-19GenentechInjection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg$6.572Code not active during this time period06/24/2021 - TBA
M0249Adm Tocilizu COVID-19 1stGenentechIntravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose$450.00[3]Code not active during this time period06/24/2021 - TBA
M0250Adm Tocilizu COVID-19 2ndGenentechIntravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose$450.00[3]Code not active during this time period06/24/2021 - TBA
Q0224Inj, pemivibart, 4500 mgInvivydInjection, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known SARS-CoV-2 exposure, and who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, and are unlikely to mount an adequate immune response to COVID-19 vaccination, 4500 mg$6,583.50Code not active during this time period03/22/2024 – TBD
M0224Pemivibart infusionInvivydIntravenous infusion, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known SARS-CoV-2 exposure, who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, includes infusion and post administration monitoring$450.00[3]Code not active during this time period03/22/2024 – TBD

[1] Providers shouldn't bill for the product if they got it for free through the USG-purchased inventory.

[1a] Payment rate effective for dates of service on or after August 15, 2022. Providers should only bill Medicare for commercially purchased products.

[2] Given the limited clinical situations allowed under the EUA, providers should only bill for tocilizumab on a 12x type of bill (TOB).

[3] We’ll geographically adjust these rates for many providers. We’ve included files with the geographically adjusted payment rates for monoclonal antibody administration in the “Additional Resources” section below. Certain settings use other payment methodologies, such as payment based on reasonable costs.

[4] On April 16, 2021, the FDA revoked the EUA that allowed for the investigational monoclonal antibody therapy bamlanivimab, when administered alone, to be used for the treatment of mild-to-moderate COVID-19 in adults and certain pediatric patients. As a result, Medicare won't pay for claims with HCPCS codes M0239 or Q0239 with dates of service after April 16, 2021.

[5] On June 3, 2021, the FDA revised the EUA for casirivimab and imdevimab to change the allowed dosing regimen from 2400 mg to 1200 mg and allow providers to administer the combination product by subcutaneous injection in limited circumstances. As a result, CMS issued a new product code for casirivimab and imdevimab (Q0244) and updated the descriptors for the existing administration codes (M0243/M0244). 

[6] On July 30, 2021, the FDA revised the EUA for casirivimab and imdevimab to allow its use for post-exposure prophylaxis (PEP) in certain adult and pediatric patients. For patients who meet the criteria for repeat dosing, the authorized dosage is an initial dose of 1200 mg, followed by subsequent repeat dosing of 600 mg once every 4 weeks for the duration of ongoing exposure. As a result, CMS issued a new product code for casirivimab and imdevimab of 600 mg (Q0240) and 2 new codes for the administration of repeat doses of casirivimab and imdevimab (M0240/M0241). Providers who administer casirivimab and imdevimab for PEP should use M0243 or M0244 for administering the first dose and M0240 or M0241 for administering subsequent repeat doses.

[7] When the government provides monoclonal antibody products to treat COVID-19 for free, providers should only bill for the administration. Don’t include the monoclonal antibody product codes on these claims. If you got the product for free and your systems require a product code to bill for the administration, enter $0.01 for the billed amount.

[8] On September 16, 2021, the FDA revised the EUA for bamlanivimab and etesevimab, administered together, to allow its use for post-exposure prophylaxis (PEP) in certain adult and pediatric patients. Providers should use Q0245 and M0245 or M0246 to bill for administering bamlanivimab and etesevimab for PEP.

[9] On January 24, 2022, the FDA announced that, due to the high frequency of the Omicron variant, REGEN-COV (casirivimab and imdevimab, administered together) isn’t currently authorized in any U.S region. Therefore, you may not administer REGEN-COV for treatment or post-exposure prevention of COVID-19 under the EUA until further notice.

[10] On April 5, 2022, the FDA announced that, due to the high frequency of the Omicron BA.2 sub-variant, sotrovimab isn’t currently authorized in any U.S. region. Therefore, you may not administer sotrovimab to treat COVID-19 under the EUA until further notice.

[11] On November 30, 2022, the FDA announced that bebtelovimab isn’t currently authorized in any U.S. region because it isn’t expected to neutralize Omicron sub-variants BQ.1 and BQ.1.1. Therefore, you may not administer bebtelovimab to treat COVID-19 under the EUA until further notice.

[12] On January 26, 2023, the FDA announced that EVUSHELD isn’t currently authorized for emergency use in the U.S.

COVID-19 Vaccine Resources

Geographically-adjusted Payment Rates

2024

Jan 1 - Dec 2024 Geographically-adjusted Payment Rates for COVID-19 Vaccine Administration & In-Home Additional Payment (ZIP) [For claims with dates of service 1/1/2024-12/31/2024]

Jan 1 - Dec 2024 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (ZIP)  [For claims with dates of service 1/1/2024-12/31/2024] * Updated 04/02/2024 to reflect the new codes for PEMGARDA [for claims with dates of service 03/22/2024-12/31/2024]

2023

Jan - Dec 2023 Geographically-adjusted Payment Rates for COVID-19 Vaccine Administration (ZIP) [For claims with dates of service 10/03/2023 through 12/31/2023] *Updated 10/05/2023 to remove codes describing the service to administer COVID-19 vaccines that are no longer authorized in the U.S. for the Novavax vaccine, Adjuvanted (effective 10/03/2023)

Jan - Dec 2023 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (ZIP) [For claims with dates of service 01/01/2023 through 12/31/2023] *Updated 07/14/2023 to reflect locality revisions for Puerto Rico (PR) and the Virgin Islands (VI)

2022

Jan - Dec 2022 Geographically-adjusted Payment Rates for COVID-19 Vaccine Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated 12/20/2022 to reflect the new codes for Moderna and Pfizer-BioNTech pediatric bivalent (updated COVID-19 vaccines) booster dose/ third dose [For claims with dates of service 12/08/2022 through 12/31/2022]

Jan - Dec 2022 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated 02/17/2022 to reflect the new codes for bebtelovimab [For claims with dates of service 02/11/2022 through 12/31/2022]

2021

Jan - March 2021 Geographically-adjusted Payment Rates for COVID-19 Vaccine Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated February 16, 2021 for addition of the COVID-19 Janssen vaccine* [For claims with dates of service of 1/1/2021 through 3/14/2021]

March - Dec 2021 Geographically-adjusted Payment Rates for COVID-19 Vaccine Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated 11/02/2021 to account for effective dates for Pfizer-BioNTech COVID-19 Pediatric Vaccine [For claims with dates of service 3/15/2021 through 12/31/2021]

Jan-May 2021 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) [For claims with dates of service of 1/1/2021 through 5/5/2021]

May-Dec 2021 Geographically-adjusted Payment Rates for Monoclonal Antibody Administration (for Providers & Suppliers Paid MPFS-Adjusted Rates) (ZIP) *Updated 12/23/2021 to account for new codes for tixagevimab co-packaged with cilgavimab* [For claims with dates of service 5/6/2021 through 12/31/2021]

 

 

Page Last Modified:
04/09/2024 11:30 AM